Endoscopy 2002; 34(5): 391-398
DOI: 10.1055/s-2002-25286
Original Article

© Georg Thieme Verlag Stuttgart · New York

Diagnosis of Gastroesophageal Varices and Portal Collateral Venous Abnormalities by Endosonography in Cirrhotic Patients

Y.  T.  Lee 1 , F.  K. L.  Chan 1 , J.  Y. L.  Ching 1 , C.  W.  Lai 1 , V.  K. S.  Leung 2 , S.  C. S.  Chung 3 , J.  J. Y.  Sung 1
  • 1Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong, China
  • 2Department of Medicine, United Christian Hospital, Hong Kong, China
  • 3Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong, China
Further Information

Publication History

7 May 2001

13 November 2001

Publication Date:
22 April 2002 (online)

Background and Study Aims: The role of endosonography (EUS) in the management of portal hypertension is not well defined. We aimed to study the use of a new generation video-echo endoscope in the diagnosis of gastroesophageal varices (GEV) and extraluminal venous abnormalities in cirrhotic patients.
Patients and Methods: Cirrhotic patients were studied by echo endoscopy to assess esophageal varices endoscopically, and gastric varices and extraluminal venous abnormalities sonographically. The results were compared with esophagogastroduodenoscopy (EGD) examination. Dyspeptic patients served as controls.
Results: A total of 52 cirrhotic and 166 dyspeptic patients were studied. EUS identified esophageal varices (EV) endoscopically in 28 patients (53.8 %), which showed a good correlation with EGD findings (r = 0.855, P < 0.001). The red color sign and portal hypertensive gastropathy were diagnosed in six and seven patients, respectively, by both methods. EUS detected gastric varices sonographically in 16 patients (30.8 %), compared with detection in nine patients by EGD. Extraluminal venous abnormalities were detected in 48 cirrhotic patients (92 %) and in only nine dyspeptic patients (5.4 %) (P < 0.001). The size of extraluminal adventitial venous dilatation was significantly correlated with the severity of GEV and cirrhosis (P < 0.001). Perforating veins were identified in all patients with GEV.
Conclusion: The new generation video-echo endoscope could be used as a single investigation in assessing both the intraluminal GEV and extraluminal venous abnormalities in cirrhotic patients. It may improve the management of patients with portal hypertension.

References

  • 1 McCormack T T, Smith P M, Rose J D. et al . Perforating veins and blood flow in oesophageal varices.  Lancet. 1983;  II 1442-1444
  • 2 Noda T. Angioarchitectural study of esophageal varices with special reference to variceal rupture.  Virchows Arch A. 1984;  404 381-392
  • 3 Spence R AJ. The venous anatomy of the lower oesophagus in normal subjects and in patients with varices: an image analysis study.  Br J Surg. 1984;  71 739-744
  • 4 Kitano S, Terblanche J, Kahn D. et al . Venous anatomy of the lower oesophagus in portal hypertension: practical implications.  Br J Surg. 1986;  73 525-531
  • 5 Hashizume M, Kitano S, Sugimachi K. et al . Three-dimensional view of the vascular structure of the lower esophagus in clinical portal hypertension.  Hepatology. 1988;  8 1482-1487
  • 6 Hashizume M, Kitano S, Yamage H. et al . Angioarchitectural classification of esophageal varices and paraesophageal veins in selective left gastric venography.  Arch Surg. 1989;  124 961-966
  • 7 Sorensen T I, Burcharth F, Aagaard J. et al . Comparison of the diagnosis of oesophageal varices by oesophagoscopy and transhepatic portography.  Liver. 1983;  3 353-357
  • 8 Hoevels J, Joelsson B. A comparative study of esophageal varices by endoscopy and percutaneous transhepatic esophageal phlebography.  Gastrointest Radiol. 1979;  4 323-329
  • 9 Lee S J, Lee K S, Kim S A. et al . Computed radiography of the chest in patients with paraesophageal varices: diagnostic accuracy and characteristic findings.  Am J Roentgenol. 1998;  170 1527-1531
  • 10 Burtin P, Calès P, Oberti F. et al . Endoscopic ultrasonographic signs of portal hypertension in cirrhosis.  Gastrointest Endosc. 1996;  44 257-261
  • 11 Schiano T D, Adrain A L, Cassidy M J. et al . Use of high-resolution endoluminal sonography to measure the radius and wall thickness of esophageal varices.  Gastrointest Endosc. 1996;  44 425-428
  • 12 Irisawa A, Obara K, Sato Y. et al . EUS analysis of collateral veins inside and outside the esophageal wall in portal hypertension.  Gastrointest Endosc. 1999;  50 374-380
  • 13 Tio T L, Kimmings N, Rauws E. et al . Endosonography of gastroesophageal varices: evaluation and follow-up of 76 cases.  Gastrointest Endosc. 1995;  42 145-150
  • 14 Boustière C, Dumas O, Jouffre C. et al . Endoscopic ultrasonography classification of gastric varices in patients with cirrhosis. Comparison with endoscopic findings.  J Hepatol. 1993;  19 268-272
  • 15 Caletti G, Brocchi E, Baraldini M. et al . Assessment of portal hypertension by endoscopic ultrasonography.  Gastrointest Endosc. 1990;  36 S21-27
  • 16 Chak A, Isenberg G, Mallery S. et al . Prospective comparative evaluation of video US endoscope.  Gastrointest Endosc. 1999;  49 695-699
  • 17 Hashizume M, Kitano S, Tanoue K. et al . Sclerotherapy-resistant esophageal varices with enormously enlarged cephalad collateral vessels predictable using portography.  Hepatogastroenterology. 1995;  42 551-556
  • 18 Dhiman R K, Choudhuri G, Saraswat V A. et al . Role of paraoesophageal collaterals and perforating veins on outcome of endoscopic sclerotherapy for oesophageal varices: an endosonographic study.  Gut. 1996;  38 759-764
  • 19 Leung V KS, Sung J JY, Ahuja A T. et al . Large paraesophageal varices on endosonography predict recurrence of esophageal varices and rebleeding.  Gastroenterology. 1997;  112 1811-1816
  • 20 Lee Y T, Lai C W, Wu J CY. et al . The use of EUS as a single investigation for dyspepsia.  Endoscopy. 2000;  32 A5
  • 21 Beppu K, Inokuchi K, Koyanagi N, Nakayama S, Sakata H, Kitano S, Kobayashi M. Prediction of variceal hemorrhage by esophageal endoscopy.  Gastrointest Endosc. 1981;  27 213-218
  • 22 de Francis R. Portal hypertension II: Proceedings of the Second Baveno International Consensus Workshop on Definitions, Methodology and Therapeutics strategies. Cambridge; Blackwell Science 1996: 2
  • 23 Faigel D O, Rosen H R, Sasaki A, Flora K, Benner K. EUS in cirrhotic patients with and without prior variceal hemorrhage in comparison with noncirrhotic control subjects.  Gastrointest Endosc. 2000;  52 455-462
  • 24 Centers for Disease Control and Prevention (CDC) .EPI INFO version 6.04. Geneva, Switzerland: USA World Health Organization. 
  • 25 Grace N D. Diagnosis and treatment of gastrointestinal bleeding secondary to portal hypertension. American College of Gastroenterology Practice Parameters Committee.  Am J Gastroenterol. 1997;  92 1081-1091
  • 26 Cales P, Zabotto B, Meskens C. et al . Gastroesophageal endoscopic features in cirrhosis. Observer variability, interassociations, and relationship to hepatic dysfunction.  Gastroenterology. 1990;  98 156-162
  • 27 Schiano T D, Adrain A L, Vega K J. et al . High-resolution endoluminal sonography assessment of the hematocystic spots of esophageal varices.  Gastrointest Endosc. 1999;  49 424-427
  • 28 Caletti G C, Brocchi E, Zani L. et al . The important role of EUS in the assessment of patients with portal hypertension.  Gastrointest Endosc. 1990;  34 154-155
  • 29 Catalano M F. Endosonographic evaluation of the patient with portal hypertension. The Cleveland experience. In Van Dam J, Sivak MV Jr, (eds) Gastrointestinal Endosonography. Philadelphia; W.B. Saunders 1999: 213-225
  • 30 Liu J B, Miller L S, Feld R I. et al . Gastric and esophageal varices: 20-MHz transnasal endoluminal US.  Radiology. 1993;  187 363-366
  • 31 Vianna A, Hayes P C, Moscoso G. et al . Normal venous circulation of the gastroesophageal junction. A route to understanding varices.  Gastroenterology. 1987;  93 876-889
  • 32 Sukigara M, Ohata M, Komazaki T. et al . Assessment of the effect of respiration on the esophageal variceal blood flow using transesophageal real-time two-dimensional Doppler echography.  Hepatology. 1988;  8 663-667
  • 33 Nakamura H, Endo M, Shimojuu K. et al . Esophageal varices evaluated by endoscopic ultrasonography: observation of collateral circulation during non-shunting operations.  Surg Endosc. 1990;  4 69-74
  • 34 Choudhuri G, Dhiman R K, Agarwal D K. et al . Endosonographic evaluation of the venous anatomy around the gastro-esophageal junction in patients with portal hypertension.  Hepatogastroenterology. 1996;  43 1250-1255
  • 35 Lo G H, Lai K H, Cheng J S. et al . Prevalence of paraesophageal varices and gastric varices in patients achieving variceal obliteration by banding ligation and by injection sclerotherapy.  Gastrointest Endosc. 1999;  49 428-436
  • 36 Irisawa A, Saito A, Obara K. et al . Endoscopic recurrence of esophageal varices is associated with the specific EUS abnormalities: severe peri-esophageal collateral veins and large perforating veins.  Gastrointest Endosc. 2001;  53 77-84
  • 37 Lahoti S, Catalano M, Alcocer E. et al . Obliteration of esophageal varices using EUS-guided sclerotherapy with color Doppler.  Gastrointest Endosc. 2000;  51 331-333

Y. T. Lee, M.D.

Department of Medicine and Therapeutics · The Chinese University of Hong Kong · Prince of Wales Hospital

Shatin, N.T. · Hong Kong · China

Phone: + 852-2632-3131

Fax: + 852-2637-5396 ·

Email: leeytong@cuhk.edu.hk